Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . r and a firm point,as a bony eminence. The temporal, facial or radialarteries may be selected as meeting this radial vessel is preferred on account of the readi-ness of access, and also from the fact that its condi-tion is not readily disturbed bv disease of the structureswhich it supplies. In order to readily appreciate all the elements of thepulse it is necessary that a certain amount of the vessel 17 258 TEE CIRCULATORY SYSTEM. be under observation. This is
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . r and a firm point,as a bony eminence. The temporal, facial or radialarteries may be selected as meeting this radial vessel is preferred on account of the readi-ness of access, and also from the fact that its condi-tion is not readily disturbed bv disease of the structureswhich it supplies. In order to readily appreciate all the elements of thepulse it is necessary that a certain amount of the vessel 17 258 TEE CIRCULATORY SYSTEM. be under observation. This is attained by the classicalmethod of placing the tips of three fingers on the radialartery, the most sensitive and most highly educatedindex finger farthest from the heart, while the thumbsupports the wrist at the back. Another is that thepatients hand and forearm is supported by the exam-iners left hand, while the forefinger of the right hand isapplied longitudinally over the artery. In this way thevessel is felt over a considerable length of its course byone finger of the observer, and varying degrees of Fig. Taking the pulse. (Musser) pressure can be applied to it, while the skin can bepushed up and the size of the artery and the characterof the arterial coats can be determined. (Sanson.) The sensation that is felt when an artery is palpatedis due to the momentary increase in arterial pressurethat occurs when the left ventricle empties itself into theaorta. The pulse wave distends the vessel that has beenpartially empty during diastole, and whose lumen isstill further narrowed by the examining finger. ;Thepulse then indicates simply the degree of duration of the PALPATION. 259 increased pressure in the arterial system caused by theventricular systole. (Broadbent.) It is necessary to bear in mind that three factors areconcerned in the production of the pulse: (1) Cardiacaction, which determines (a) frequency (fast or slow),(b) force (strong or weak), (c) rhythm (regular,
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